Fibromyalgia
First line
Pregabalin is -approved for fibromyalgia (one of three drugs with this indication, alongside duloxetine and milnacipran). Dose 150–450 mg/day. Pain effect is modest (NNT 8); sleep effect is more noticeable.
Gabapentinoids (antiepileptics)
ATC code: N03AX16 (Pregabalin)
Brand names
Lyrica, Lyrica CR
GABA analogue that, like gabapentin, binds the α2δ subunit of voltage-gated calcium channels in the CNS. Inhibits excitatory neurotransmitter release. Compared with gabapentin, pharmacokinetics are more linear — bioavailability 90 % regardless of dose, simplifying titration. Effects on neuropathic pain and anxiety are comparable to gabapentin at much lower doses. Controlled substance: Schedule V in the US (since 2005) and Schedule 3 in the UK (since 2019).
First line
Pregabalin is -approved for fibromyalgia (one of three drugs with this indication, alongside duloxetine and milnacipran). Dose 150–450 mg/day. Pain effect is modest (NNT 8); sleep effect is more noticeable.
First line
First-line for neuropathic pain per NeuPSIG 2015 and IASP 2022. Used in diabetic polyneuropathy, post-herpetic neuralgia, and spinal pain. Start 75 mg twice daily; titrate to 150–300 mg twice daily. Max 600 mg/day. Onset 1–2 weeks — faster than gabapentin.
Second line
In Europe, pregabalin is -approved for generalized anxiety disorder; not in the US. Per NG113, second-line after SSRI/SNRI failure. Dose 150–600 mg/day. Efficacy comparable to SSRIs with faster onset (1–2 weeks vs 4–6). Advantage: no sexual dysfunction. Disadvantage: dependence/abuse risk, weight gain.
Not recommended
— Stress and non-clinical anxiety: Self-medication with pregabalin (Lyrica) for stress, insomnia, or emotional tension without a clinical diagnosis is unsafe. Controlled substance: Schedule V in the US, Schedule 3 in the UK (since 2019), restricted prescription in Russia (since 2019). In patients with prior substance use disorder, pregabalin dependence risk is significant. On black markets in Eastern Europe and the CIS, Lyrica is among the most abused drugs in young adults. After long-term use, abrupt discontinuation produces a withdrawal syndrome: anxiety, insomnia, tachycardia, sweating, diarrhea, seizures.
FDA categories were retired in 2015. Teratogenicity data are mixed — Nordic registry data did not confirm increased malformation risk, but earlier studies signaled concern. In pregnant patients with epilepsy or severe neuropathic pain, individualized decision-making applies. For anxiety in pregnancy, SSRIs are preferred.
Transfers into breast milk. Manufacturer label advises against breastfeeding. Per LactMed, use when necessary with infant monitoring for sedation and poor weight gain.
pregabalin is evaluated for the following indications with varying evidence strength: Fibromyalgia (evidence tier A), Neuropathic pain (evidence tier A), Generalized anxiety disorder (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of pregabalin (≥ 1 in 100): Sedation, drowsiness, Dizziness, Weight gain (5–10 kg over 6 months), Peripheral edema, Dry mouth, Euphoria (some patients welcome it, increasing abuse risk). See the Safety section for uncommon and serious reactions.
FDA categories were retired in 2015. Teratogenicity data are mixed — Nordic registry data did not confirm increased malformation risk, but earlier studies signaled concern. In pregnant patients with epilepsy or severe neuropathic pain, individualized decision-making applies. For anxiety in pregnancy, SSRIs are preferred.
Transfers into breast milk. Manufacturer label advises against breastfeeding. Per LactMed, use when necessary with infant monitoring for sedation and poor weight gain.
pregabalin is contraindicated in: Hypersensitivity; Age under 18 (for most indications except pediatric epilepsy from age 4); Rare hereditary galactose intolerance. Full list in the Safety section.
pregabalin is a controlled substance with dependence and abuse risk. Use without a clinical diagnosis is unsafe.
pregabalin causes sedation, but as a side effect — not as an indication. For insomnia, drugs with better safety profiles exist (melatonin, short-course doxylamine, third-generation hypnotics on indication). Self-medicating insomnia with pregabalin is unjustified.